Publications (29)122.67 Total impact
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Dataset: Zhang et al., '11
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Article: Trauma Informed Care for Primary Care: The Lessons of War.
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ABSTRACT: More than 2 million Americans have deployed to the wars in Iraq and Afghanistan over the past decade. For these individuals, anticipated and actual exposure to life-threatening events were a routine part of daily life. Similarly, natural disasters, such as Hurricane Katrina, the recent natural and man-made consequences of the Japan earthquake and tsunami, the massive Southeast Asia tsunami of 2005, and tornadoes tearing through the Southeast United States, have placed in graphic relief the traumatic events that affect many millions of lives every year. Even in our everyday life (and medical practice), trauma is everpresent: sexual assault, domestic violence, gang shootings, and accidents. In the United States, over 10 million motor vehicle accidents result in more than 35 000 deaths each year (1). If we told our hospitals that 34% of everyone in the intensive care unit had a staphylococcal infection, they would immediately institute screening, treatment, and observation. Yet we know that approximately that rate of posttraumatic stress disorder (PTSD) occurs in patients presenting to hospital trauma units after serious motor vehicle accidents. Regardless, assessment for PTSD and other trauma-related disorders is not a standard of care in emergency departments, nor in outpatient settings where many patients affected by trauma present.Annals of internal medicine 09/2012; · 16.73 Impact Factor -
Article: Startle response related genes.
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ABSTRACT: The startle reaction (also known as the startle response, the startle reflex, or the alarm reaction) is the psychological and physiological response to a sudden unexpected stimulus, such as a flash of light, a loud noise (acoustic startle reflex), or a quick movement near the face. Abnormalities of startle response have been observed in many stress-related mental disorders, such as schizophrenia and post-traumatic stress disorder (PTSD). However, the molecular mechanisms of startle in stress-associated conditions--for example, whether the startle reaction is associated with any gene variance--is still unknown. In this paper, we will carry out a systematic review by retrieving, assessing, and combining, when applicable, individual studies investigating association of the molecular variation of candidate gene with the startle response. The systematic review is based on the search for numerous publications using the keywords "startle gene" on September 15, 2010 using PubMed, which comprises more than 20 million citations for biomedical literature from MEDLINE and life science journals. A total of 486 publications regarding genes associated with startle have been obtained and reviewed here. There are fewer than 20 publications associating genes with the startle response between 1979, when the first valuable paper was published, and 1999. However, publications have dramatically increase from 2001 and reaches over 70 in 2009. We have characterized them into three categories: startle-associated gene studies in humans, in animals, as well as in both human and animals. This review of research strategy may provide the information for identifying a biomarker for startle response, with the objective of translating research into clinical utility: diagnosis and treatment of stress-induced mental disorders.Medical Hypotheses 08/2011; 77(4):685-91. · 1.39 Impact Factor -
Article: Posttraumatic stress disorder from Vietnam to today: the evolution of understanding during Eugene Brody's tenure at the journal of nervous and mental disease.
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ABSTRACT: The psychological and behavioral consequences of exposure to traumatic events have been described throughout our history. However, the term posttraumatic stress disorder (PTSD) was not formally introduced into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, until after Dr Eugene Brody--whose broad interests included refugee populations and victims of trauma--had already served as editor-in-chief of the Journal of Nervous and Mental Disease (JNMD) for 15 years. Advances in molecular biology, genetics, and imaging that occurred during Brody's tenure at the JNMD contributed significantly to our current understanding of the human fear response and the neurobiology of PTSD. Comprehensive treatment guidelines summarizing evidence-based treatment were published during his tenure, and the most recent American Psychiatric Association update to practice standards was published in the year before his passing. Thus, this review of the history and present state of the science of PTSD summarizes the lessons learned while Dr Brody dedicated his life to teaching us.The Journal of nervous and mental disease 08/2011; 199(8):544-52. · 1.77 Impact Factor -
Article: P11 expression and PET in bipolar disorders.
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ABSTRACT: Bipolar disorder (BD) is a common mental disorder, subdivided into BD-I and BD-II. Currently, few biomarkers differentiate BD-I from BD-II. However, it is suggested that peripheral blood mononuclear cell (PBMC) mRNA levels of p11 and positron emission tomography (PET) might be potential biomarkers for BD. Healthy controls (HCs), BD-I, and BD-II patients in remission (n = 20 in each group) underwent a resting PET study with the radiotracer [(18)F]-2-deoxy-2-fluoro-d-glucose ((18)F-FDG). PBMC p11 mRNA levels were determined by quantitative real-time PCR. Comparing BD patients to HCs, normalized glucose metabolism (NGM) was higher in the hippocampus, parahippocampus, and amygdala, but lower in the anterior cingulate cortex (aCC), medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex (dlPFC), insula and thalamus. Compared to BD-II, BD-I had hypometabolism of glucose in the aCC, bilateral middle and inferior gyrus, insula and striatum, and hypermetabolism of glucose in the left parahippocampus. PBMC p11 mRNA was over-expressed in both BD-I and BD-II, although there was no significant difference in its expression levels between BD-I and B-II patients. Further, there were significant positive correlations between PBMC p11 mRNA and NGM in the mPFC, aCC, left insula, bilateral orbitofrontal cortex (OFC), and left middle, inferior and superior temporal gyri. Also, PBMC p11 mRNA was positively correlated to the number of depressive episodes in BD patients, especially in BD-I patients. This study demonstrates that PBMC p11 mRNA expression is associated with neural activation in the brain of BD patients and warrants a larger translational study to determine its clinical utility.Journal of psychiatric research 06/2011; 45(11):1426-31. · 3.72 Impact Factor -
Article: P11 (S100A10) as a potential biomarker of psychiatric patients at risk of suicide.
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ABSTRACT: Although suicide represents 1.8% of the global burden of disease, there are few objective assays for suicide risk. Being associated with depressive disorders, which have a high risk of suicide, the proteins P11, P2RX7, and S100β may be biomarkers for a suicidal disposition. We measured levels of p11 and P2RX7 mRNA in peripheral blood mononuclear cells (PBMCs) of 26 psychiatric patients (11 suicide attempters, 15 suicide non-attempters) with post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), and 14 normal controls, using quantitative real-time PCR. We also conducted a meta-analysis of microarray data of p11, P2RX7 and S100β from post-mortem prefrontal cortex (PFC) of patients who committed suicide (n = 56) and non-suicide controls (n = 61). We found that PBMC p11 mRNA levels were significantly lower in suicide attempters and higher in suicide non-attempters, when compared to normal controls. The PFC p11 mRNA levels in suicide completers were also lower than non-suicide controls (adjusted p = 0.007). Unlike p11, PBMC P2RX7 mRNA levels were significantly lower than normal controls in all patients including suicide attempters, suicide non-attempters, and suicide completers. In addition, levels of S100β in PFC did not differ between suicide completers and non-suicide controls. These results suggest that PBMC p11 mRNA levels may be a potential adjunctive biomarker for the assessment of suicide risk in mental disorders and warrants a larger translational study to determine its clinical utility.Journal of psychiatric research 04/2011; 45(4):435-41. · 3.72 Impact Factor -
Article: Impact of soldier suicide on unit and care givers: implications for education and training.
Psychiatry Interpersonal & Biological Processes 01/2011; 74(2):124-6. · 3.16 Impact Factor -
Article: Military and civilian disaster response and resilience: from gene to policy.
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ABSTRACT: Disasters, such as war, terrorism, and natural disasters, affect individuals, groups, and communities. Although the focus is often on post-traumatic stress disorder (PTSD), it is only one of many potential responses to traumatic experiences. Fostering community and individual resilience can help mitigate the effects of disaster. Research, education, and early intervention are integral tools to inform an effective response. The Center for the Study of Traumatic Stress (CSTS) at the Uniformed Services University of the Health Sciences ascribes to such a model in its approach. Recent studies confirm that appreciation of biology and its relation to trauma response are necessary to our understanding of trauma's effects on humans, including trauma-associated disorders, resiliency, and recovery.Military medicine 07/2010; 175(7 Suppl):32-6. · 0.92 Impact Factor -
Article: Ethical considerations in military psychiatry.
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ABSTRACT: Military psychiatrists are faced with multiple, difficult questions that shape the context for ethical patient care. These questions are difficult to answer and future efforts, including policy and evidence-based treatment practices, should aim at reducing the ambiguity faced by military psychiatrists. New research should focus on issues as diverse as optimal approaches to informed consent, evidence-derived approaches to protecting confidentiality, outcomes of care for individuals in widely varying military roles, and medication use in the field. Training for mental health care providers who deal with military patients should be provided not only in military graduate medical education but also in job-specific courses and in ethics. This should include specific training for personnel who will be dealing with specific populations, such as the US Army's current "Dealing with Detainee course" and the Army Medical Department's "Combat Operational Stress Course" for deploying military psychiatrists and psychologists.The Psychiatric clinics of North America 07/2009; 32(2):271-81. · 1.87 Impact Factor -
Article: PTSD and traumatic stress from gene to community and bench to bedside.
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ABSTRACT: Individuals and communities are exposed to traumatic events, those that are accidents or naturally occurring and those that are intentional or human made. Although resilience is the expected response, for some, posttraumatic stress disorder may be the outcome. Brain models of PTSD require understanding the phenomenology of the disorder and the brain "break down" that occurs. Among several models, importantly, is the perspective that PTSD is a "forgetting" disorder. Other elements in the onset and triggers of PTSD can identify further models to examine at the bench. New studies of the 5-HT(2A) receptor, the glucocorticoid receptor, p11, mitochondrial genes and cannabinoids are bringing new perspectives to understanding brain function in PTSD. Effective treatments indicate areas for bench research on the mechanisms of the disorder.Brain research 04/2009; 1293:2-12. · 2.46 Impact Factor -
Article: Applicability in highly industrialized, resource rich Communities: the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
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ABSTRACT: Both natural and human made disasters create distress in large populations. The IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings set forth principles and a system for their employment, aimed at minimizing the psychological consequences of public health emergencies created by disasters. Guidelines cannot dictate which principle, or principles, of mental health and psychosocial support have the most relevance to the needs of a specific culture in a specific disaster. However, recent experience in the United States suggests that the core principles articulated in the guidelines are appropriate for use in industrialized and resource rich nations, and that approaches outlined within the guidelines are of practical use in these populations.Intervention 10/2008; 6(3):243-247. -
Article: Exposure to war as a risk factor for mental disorders.
PLoS Medicine 05/2008; 5(4):e82. · 16.27 Impact Factor -
Article: Models of PTSD and traumatic stress: the importance of research "from bedside to bench to bedside".
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ABSTRACT: The epidemiology and psychology of PTSD noted above is not often considered in neurobiological models of PTSD. Neurobiological models tend to focus on symptoms. This is an important perspective but it does not capture the brains total response to traumatic events. Similarly, neurobiologists have rarely used the extensive knowledge of animal behavioral responses to stress as a means to define the human stress phenomenology, looking for the human equivalent (rather than the other way around). The development of animal models for PTSD and other traumatic stress-related brain changes is an important part of advancing our neurobiological understanding of the disease process as well as recovery, resilience, and possible therapeutic targets. Animal models should address symptoms but also other aspects of PTSD that are seen in clinical care including the waxing and waning of symptoms, Understanding "forgetting", toxic exposure, failure to recover and how the neural systems fail rather than function are important perspectives on developing animal models. The cognitive process of identification is another important animal model to develop. Using these perspectives recent work has shown new avenues for understanding the trauma response in animal models and human brain tissue of individuals with PTSD. The 5-HT2A receptor and p11 protein and associated regulators are avenues of new investigation that warrant study and consideration in models of PTSD.Progress in brain research 02/2008; 167:203-15. · 3.04 Impact Factor -
Article: Workplace resources for crisis management: implications for public-private sector planning, policy and response to disasters
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ABSTRACT: The interface and cooperation of the public and private sector is essential in disaster planning and response at the federal, state and local level. The resources of private industry and the integration of resources from multiple corporations have been proven necessary for effective community and regional responses to large-scale disasters (natural disasters, terrorism, bioterrorism and the threat of a pandemic). Large corporations often possess sophisticated crisis management capabilities that may exceed the disaster response capacities of the communities in which they are located. Important crisis management resources of large employers that have implications for community planning and response to disasters include the corporation's security and threat assessment, communications, human resources and Employee Assistance Programmes (EAP). Workplace preparedness influences family and community preparedness and impacts population health, safety and resilience. Workplace crisis resources, often forgotten and untapped by public sector planners, need to be considered in the continued development and implementation of disaster planning and response policies.International Journal of Public Policy 02/2008; 3(5):378-388. -
Article: Psychiatric medications for deployment: an update.
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ABSTRACT: This article discusses issues regarding the usage of psychotropic medications during military deployments, with emphasis on Operation Iraqi Freedom. The role of psychotropic medications in the Army combat stress control doctrine is reviewed and compared with operational experiences of psychiatrists who have deployed to Iraq, Bosnia, and Egypt. Many issues regarding psychotropic medications experienced by deployed psychiatrists are not discussed in the Army combat stress control doctrine. The advent of new psychotropic medications, the changes in the types of conflicts fought, and the role of National Guard and Reserve forces in current conflicts have all had an impact on the role and usage of psychotropic medications during military deployments.Military medicine 08/2007; 172(7):681-5. · 0.92 Impact Factor -
Article: First responders: mental health consequences of natural and human-made disasters for public health and public safety workers.
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ABSTRACT: First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.Annual Review of Public Health 02/2007; 28:55-68. · 5.45 Impact Factor -
Article: "Just-in-time" mental health training and surveillance for the Project HOPE mission.
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ABSTRACT: Immediately before the first sailing of the USS Mercy/Project HOPE relief mission to Southeast Asia, the mission leadership initiated presailing orientation and training and a program of survey-based health surveillance for mission participants. The training and surveillance efforts included a focus on mental health aspects of the mission. At the conclusion of the predeployment mental health training, a voluntary, anonymous, predeployment survey was administered to members of the Project HOPE team. A second survey was administered approximately 3 months after return from the mission. The surveys were also administered before and after the second sailing of the USS Mercy/Project HOPE mission, although the training was not repeated. The sample size prevented statistical analysis of predeployment and postdeployment rates of illness; however, there was no evidence of incidence beyond population baseline rates. Responses to questions regarding perceptions of mission success and personal achievement were quite favorable, whereas specific questions regarding shipboard resources, training, and professional interactions were met with more variable responses. Response rates suggest a strong interest among participants in efforts to address the Project HOPE program and resources. They also suggest resilience among participants and areas for improvement in communication among participants.Military medicine 11/2006; 171(10 Suppl 1):63-5. · 0.92 Impact Factor -
Article: Beyond post-traumatic stress disorder.
Biosecurity and Bioterrorism 02/2005; 3(2):164-5. · 1.94 Impact Factor -
Article: Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder.
American Journal of Psychiatry 12/2004; 161(11 Suppl):3-31. · 12.54 Impact Factor -
Article: Prisoners of war: long-term health outcomes.
The Lancet 01/2004; 362 Suppl:s22-3. · 38.28 Impact Factor
Top co-authors
Top Journals
Institutions
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2011
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Texas Tech University Health Sciences Center
- Department of Psychiatry
Lubbock, TX, USA
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1970–2011
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Uniformed Services University of the Health Sciences
- • Department of Psychiatry
- • Department of Medicine
Bethesda, MD, USA
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2002
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Walter Reed National Military Medical Center
Washington, D. C., DC, USA
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